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Opioid use disorder, which claims 115 lives a day by overdose in the United States, is a complex, chronic medical condition, but one that can be successfully treated with proven medications. And yet, one of the oldest and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws.

Of the three medications approved by the Food and Drug Administration to treat opioid use disorder, federal law relegates only methadone to be dispensed in separate clinics apart from the general health care system. It’s not unusual for methadone clinics to be in out-of-the-way locations and often inaccessible by public transportation, especially in rural and suburban communities. When individuals trying to break an addiction to opioids can’t get to a methadone clinic on a daily basis, they can’t get treatment.

The other two federally approved medications, buprenorphine and naltrexone, can be prescribed and administered in primary care settings, where treatment can take place as part of an overall clinical care plan.

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Methadone is typically taken daily in a highly structured setting, an approach that benefits many patients. But methadone should be treated no differently than other FDA-approved medications for opioid use disorder. As we write in the New England Journal of Medicine, it’s time for Congress to remove this barrier to treatment and allow methadone to be prescribed in primary care settings, as well as in existing standalone clinics.

Only about 20 percent of Americans who have an opioid use disorder are being treated with buprenorphine, naltrexone, or methadone, a woefully small percentage that shows the extent of the barriers to treatment that we need to remove to stop this public health crisis. Restricting the availability of methadone to designated clinics has contributed to this treatment gap.

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Methadone has been available by prescription in primary care clinics in Canada since 1963, in Great Britain since 1968, and in Australia since 1970. In these places, methadone is the most commonly prescribed treatment for opioid use disorder, and it isn’t controversial because it has been shown to benefit the patient, the care team, and the community.

Methadone works. In a 2017 review of all causes of death among people with opioid use disorder, those receiving this medication were one-third less likely to have died during the study period than those not treated with methadone.

Methadone is a synthetic opioid that reduces cravings and withdrawal symptoms for heroin and other opioids. Developed in 1937 as a pain medication, it was first studied as a treatment for heroin addiction in New York City in the 1960s.

By the 1970s, the system for delivering methadone that we know today had been fully developed. Patients visit a designated clinic, typically every day, take methadone under observation, and get specialized, highly structured care, including counseling and periodic drug tests.

The methadone clinic model was carved into law in the United States in 1974, when Congress passed the Narcotic Addiction Treatment Act. The regulations around methadone, driven by fears of accidental overdose and diversion, evolved in such a way that primary care physicians almost never delivered methadone treatment. Stigma and a not-in-my-backyard mentality resulted in the placement of a sizable number of methadone clinics in locations that were hard for many to reach.

The last time Congress expanded access to medication for opioid use disorder in primary care was when it passed the Drug Addiction Treatment Act of 2000. It allowed physicians to prescribe and administer buprenorphine in their offices, making this medication more available to thousands of patients. But the barriers to the delivery of methadone remain intact.

Methadone has saved many lives and could save many more. Several studies have shown that methadone treatment in a primary care setting is both feasible and successful. In rare cases, it has been allowed in primary care offices. Our experience in Boston over a 10-year period with a limited number of patients who received methadone treatment in a primary care setting after being stable in a methadone clinic was excellent, with no adverse incidents.

We call on Congress to allow methadone treatment to be delivered in primary care settings, as well as through special methadone clinics. That would be just the beginning. We also need to enhance physician training about opioid use disorder, create incentives for prescribing medications to treat it, and integrate treatment into existing models of care.

From the federal government down to community partners, we are all desperately searching for solutions to stem the opioid epidemic. Increasing the availability of medications that can effectively treat opioid use disorder — including methadone — will be essential if we are to succeed in saving lives.

Jeffrey Samet, M.D., is the chief of general internal medicine at Boston Medical Center and a professor of medicine at Boston University School of Medicine. Michael Botticelli is the executive director of the Grayken Center for Addiction at Boston Medical Center. Monica Bharel, M.D., is the commissioner of the Massachusetts Department of Public Health.

  • I believe it should be able to be dispensed by your personal doctor.Having said that, I don’t believe anybody needs more than 40mg and patients should earn the right with good behavior to get it from there own doctor . There are still quite a few patients in clinics who just abuse other drugs while enrolled.

    • I apologize for my comment claiming plagiarism. I did not notice that the two articles have the same author. Sorry for false claims.

    • Hey Mac, who cares? Nobody cares. We are worried about changing the status quo and trying to win lives. You are part of the problem. Did you intend to discredit this person? Does that somehow trump the real problem? You are either part of the solution or part of the problem. The whole system is screwed because people like you make policy.

    • Yes, buprenorphine single ingredient tablets (subutex, not suboxone) has been fda approved for chronic pain management. Subutex is not marketed as a brand name drug in the US anymore, but generic options are available. Anybody telling you generic is any different in quality from brand name is either lying, paranoid, or is convinced with their opinionated bias.

  • To Frank; You are spot on about stating that pain management people are no different than anyone else who are opioid dependant. The only thing that makes it different is when they are calling us “junkies” because we attend a methadone clinic. I hate that word. IT is a decades old label that does not explain being opioid dependant especially since the drug companies have contributed so much to the problem. I have been on methadone many years and if not for it I would be dead or in prison still. I would not have raised my children and have went to college for a certificate in medical office. Some of us did not start treatment in a doctors office we needed recovery along with medication. We are not just “junkies” we have a medical disease that takes its toll on us and our families as well. Yes Frank so many of us need to speak up on how this medication has helped us get out of active addiction and be productive citizens. Methadone is not the only answer but it is a good start! I was one who had many relapses until I figured out this is a disease and I needed help to not repeat it over and over. The clinics are not perfect but we knew the medication was taking away our cravings and we could see a better future. We are not just “junkies”. I am a grandmother and have not used illegal drugs since I have been on the program. I have been compliant with all rules and it would be great for my medical doctor who knows me well to prescribe it at this time of my life. I get the most take homes that are allowed. I think my doctor who knows more about my other health conditions can make a informed decision on writing out a prescription that works for me along with all of my health care. Methadone is not a quick answer for this disease but it is great start at living a normal life when you admit to yourself you have it. Those of us that have proven our desire to stay in recovery should speak up and bring about change.

  • I have been on methadone now for about 10 years I was taking vicodin from a accident involving me falling off of a 6′ ladder and hitting the concrete floor causing me to have two problems I had to have surgery for my lower back and the same thing with my neck and my doctor explained to me that I would not be able to work anymore due to extreme amount of pain and I probably will have to live with it for the rest of my life, how I ended up getting the methadone was because I had liver disease from hepatitis c that I picked up most likely from having unprotected sex, after all these years and I have had no problems getting my monthly supply, one good thing about it all is I was able to get cured from the hepatitis, good luck to all that are trying to get pain medication from a doctor that cant feel your pain and give you the help you need, not all people that are trying to get pain management are not junkies that just need help

    • You of all people shouldn’t be tossing through word junkie around . Because you my friend are no different than anyone else who took opiates and got dependent on them . The only difference between you and someone you consider a junkie is supply , you haven’t had yours interrupted and haven’t had to beg , borrow and steal for it which Is how it should be , stop taking your meds and try to imagine not being able to get anymore and let the withdrawals set it and then look in the mirror and rethink you comments because you to are a junkie ! Everyone is taking opiates to avoid pain ! Stop taking them and pain is all you get . Just like if you stopped eating or drinking . If they made opiates available to everyone and regulated the dosage so overdose could be avoided then no one would know who was on them . But we all like to have a group of people to shit on , to say we are better than them . History shows it . Race wars , genocide . Addicts are the new inferior race who have no rights . We need to march on Washington all of us to get our civil rights ! Stay out of healthcare America . But I believe it’s the people who see methadone in a blood test of a loved one who died and blames methadone not the 7 other drugs that caused it and cry and go to congress and testify against it . We need all the people who have had great lives to testify and prove it can be used to save life . But it’s like admitting your Jewish in nazi Germany that’s how the government and healthcare workers look at someone on methadone, less than human , undeserving of the same Luxuries as the rest of us so stop calling people junkies. It’s a disease and needs to be treated as such

  • I applaud this article. An addict that has gone to a clinic for years should be able to get Methadone from their primary doctor. Driving daily to a clinic makes it hard to maintain a job and be productive in society. The clinic has delays that make the addict late for work or too late to make it to work. Are Americans not as intelligent as people from UK or Canada or Australia? Our law is antiquated. Please get this law changed to help these addicts. Thank you

  • I couldnt agree more. Its time to get methadone more available to addicts. I have been an addict of herion and pills for 15 years. I was doing so good in Colorado going to the methadone clinics i never relapsed for a whole year and then i had to move to pocatello idaho. I searched for help but alls that is available is suboxone. I cant take it i have intolerable side affects from it ive tried it three times everytime i fail because its just a med i cant take . so once i found a dr here i n pocatello he could only taper me off the methadone and try the suboxone. So let me remind you i was on a high dose of methadone 140 mgs it took me a a good 8 months to get to that dose and i got ripped off it in 3 months and tried the suboxone again and failed. So here I am with no help at all not because i dont want it but because no dr here can prescribe methadone for substance abuse. So what choice do i really hace but to go back to the heroin so im not sick. I didnt want this im so angry i was working got my license back. Got a car i havent worked or cared to in 12 years . i was doing amazing a feeling amazing and now im at groud zero. I cry all the time i want help but there is none im letting my family down myself but what choice do i have i cant function without anything i get to sick . i think this is wrong i think the system has let me down and i blame. All you congresss that wont pass the bill to help addicts like me that really wants it . i hope to god that you someday get to see first hand what im saying maybe it might be yourself your kid your wife husband mom dad that ends up being pushed out the door when your crying and begging for help but there isn’t none so they end up back down the wrong path and then you get the call that your loved one was just found dead from an overdose pf herion. Maybe then you might think about what others are dealing with and pass the damn bill. If you want to get a handle on the epidemic then allow drs every where to prescribe methadone in a primary care setti g or get a clinic going in every town that has ove 60.000. This is not fair .

  • You are dreaming if you think that they will ever allow PCP to prescribe methadone. In fact they are moving in the opposite direction by scaring pain management doctors (the only one able to prescribe methadone) into limiting the amount they feel comfortable prescribing to only 30 mgs a day. These bureaucrats in government are destroying my life. I hate to sound cold but I don’t care if other people can’t control themselves and overdose, if you are that reckless thats your bad not mine.

    • Let me guess your not addict you just need it for pain .i got news for you once you are physically dependent your in the same boat as someone who picked up dope in street you can’t stop , how do you think 90% of addictions start ? A Dr gave it to them first when they most likely didn’t even need it . You just happen to convince your doctor to keep giving it to you or if it’s not you all the people in (pain ) clinics do, I can’t stand people who actually think because they go to a pain clinic that they are better than people in methadone clinics , the only difference is if a dr cuts you off and that is something that can happen any time , if you think I’m being mean then sorry , but I if all the people in pain management had overdosed then all their pills wouldn’t of been sold on the street .

  • Making addicts congregate somewhere to get their medicine is a huge trigger. Many people go to the spot straight from the clinic after meeting using buddies at the clinic. This drug needs to be put into normal prescription schedules and guidelines.

  • Canada , England and other countries all have doctors prescribing Methadone and consider addiction a disease that’s best treated like all other medical issues and the stigma isn’t as bad in those countries, and they have better outcomes ,bottom line is politicians that have been in office for 20 -30 years are set in their thinking and nothing will change until they go away and are replaced with caring people. Addiction is a disease of the mind not a crime that needs punishment. The way these clinics treat people is criminal . Forcing people who haven’t used a illegal drug in 15-20 years to go to counseling still and stand in line with active drug users is wrong .at the very least you should only have to do a few years in clinic and if you do everything right be able to move on to a regular doctors office , not be punished for life .

    • 9 years now. I still have to come in at 9 am with all the addicts. This should be a take home, bi-monthly refill, and you get your own dr. Tired of these “methadone troughs”

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